Psychogeriatric SOS: A unique clinician-to-clinician web-based service for rural and remote clinicians

Jacqueline Huber; David Burke

摘要

Introduction: The Norwegian Anti-Discriminatory and Accessibility Act adopted in 2008 states that web based electronic services geared towards the public should be accessible to all. Today, the web content accessibility guidelines (wcag-2) is an agreed standard in Norway. However, it should be fair to state that the developers of Norwegian e-health services have not focused on universal design to any particular extent. To obtain a brief estimate of the status in the field, we have investigated the accessibility to some randomly selected e-health services, applying a ad hoc user panel of 4 persons. Methods and materials: We have during 2015 set up a Windows 7 machine with NVDA synthetic speech output and a Brazie Powerbraille display installed. Using Mozilla Firefox, we have investigated the accessibility to 11 Norwegian web based health services. Our investigation included state, municipal and private service providers. The wcag-2 standard and “Referansekatalogen for e-helse” constituted the point of offset for our evaluation. Four users were given specific tasks in connection with each website, and we observed and interviewed the informants as they interacted with each service. We focused especially on the users' ability to operate the services with the keyboard, and if all the functionality on the web pages could be utilized without applying a mouse. Results: The Helseportalen (https://helsenorge.no) provides access to the electronic health record for Norwegian citizens and constitutes a major national initiative in the field of e-health. To which extent can this service be regarded as universally accessible? The html code was found to be robust and consistent, and the functionality, which we investigated, could be operated by the keyboard. This was not true for all of the services, which we evaluated. The login to Helseportalen can be done with mobile bank id, or by a code generator equipped with synthetic speech. However, the initial registration of login method could not be performed by our users. The login to Helseportalen relies on services from private enterprises, and are not necessarily free of charge. The quality of the code on the various sites varied considerably, which potentially causes problems for users of peripheral equipment. Inconsistent use of html headline-tags slows down navigation on several of the evaluated pages. Multimedia content is not followed by a descriptive text (not required by wcag-2 level aa). Discussion: If the construction of e-health services is regarded a work process involving planning, prototyping, implementation, testing, refinement and documentation, the users should be involved in each of this phases to ensure accessibility to the services made. User oriented design methods have a stronghold in Scandinavia, but if for economic or practical reasons such approaches are not regarded feasible, expert evaluations with emphasis on accessibility should be performed on each stage in the development cycle. Background : Rural mental health services are under-resourced and over-burdened. Given the aging population and escalating health costs, we need to innovate to solve this resourcing crisis. Psychogeriatric SOS is a unique service that offers information, advice, supervision, training, education and case conferencing to rural and remote clinicians working with older adults across all disciplines, allowing them to establish a supportive professional relationship with our psychogeriatric multidisciplinary team via a web-conferencing platform. This nascent service has the potential to be a pathway for more efficient use of time for primary clinicians and specialty psychogeriatric services. Aims: To describe rural clinician/user demographics, delineate how this model satisfies unmet clinician professional needs, and determine whether it improves clinician confidence. It will also provide a forum in which members of the Australian GP community can make comments and suggestions. Methods: Rural and remote clinicians in three under-resourced local health districts in NSW and one NGO were provided this service in 2015. During the first 12 months, demographic data, uptake rates, user satisfaction, and pre- and post- intervention clinician confidence measures were collected. Results: 100 registrants participated in a combination of 15 education forums, 25 case conferences and 14 supervision sessions. Confidence questionnaires indicated confidence depended on clinician, context of practice, and number of years practicing (with those having worked 1-5 years being the most confident followed by those having worked more than 21 years). The most prominent areas of need identified by clinicians were educating patients’ carers, and education and case conferencing around clinical psychogeriatric issues. All users returned to use the service more than once. Conclusion: There is a need for the Psychogeriatric SOS model of e-health rural outreach, which may constitute a step towards the more

机译：简介：2008年通过的《挪威反歧视和无障碍法案》指出，面向公众的基于Web的电子服务应为所有人使用。今天，Web内容可访问性指南（wcag-2）已成为挪威公认的标准。但是，应该公平地说，挪威电子医疗服务的开发人员并没有在任何特定程度上关注通用设计。为了获得对该领域状态的简要估计，我们使用一个由4人组成的临时用户面板，调查了一些随机选择的电子医疗服务的可访问性。方法和材料：我们在2015年安装了一台Windows 7计算机，该计算机配备NVDA合成语音输出和Brazie Powerbraille显示器。使用Mozilla Firefox，我们调查了11种挪威基于Web的健康服务的可访问性。我们的调查包括州，市和私人服务提供商。 wcag-2标准和“ e-helse的Referansekatalogen”构成了我们评估的偏移点。四个用户被赋予与每个网站有关的特定任务，并且当他们与每个服务进行交互时，我们观察并采访了信息提供者。我们特别关注用户使用键盘操作服务的能力，以及是否可以在不使用鼠标的情况下利用网页上的所有功能。结果：Helseportalen（https://helsenorge.no）为挪威公民提供了电子健康记录的访问权限，并构成了电子卫生领域的一项重大国家计划。在何种程度上可以将此服务视为普遍可访问的？发现html代码健壮且一致，并且我们研究的功能可以由键盘操作。对于我们评估的所有服务，情况并非如此。可以使用移动银行ID或配备合成语音的代码生成器来登录Helseportalen。但是，我们的用户无法执行登录方法的初始注册。 Helseportalen的登录依赖于私人企业的服务，并且不一定是免费的。各个站点上的代码质量差异很大，这可能会给外围设备用户带来麻烦。 html标题标签的使用不一致会减慢某些评估页面上的导航。多媒体内容后没有描述性文本（wcag-2级别aa不需要）。讨论：如果将电子卫生服务的建设视为涉及计划，原型制作，实施，测试，完善和文档编制的工作流程，则用户应参与每个阶段，以确保对所提供服务的可访问性。面向用户的设计方法在斯堪的纳维亚半岛具有重要据点，但是如果出于经济或实践原因，认为这种方法不可行，则应在开发周期的每个阶段都进行以可访问性为重点的专家评估。背景：农村精神卫生服务资源不足且负担过重。鉴于人口老龄化和医疗费用不断上涨，我们需要进行创新以解决这一资源危机。精神科SOS是一项独特的服务，可为与各个学科的老年人合作的农村和偏远临床医生提供信息，建议，监督，培训，教育和案例会议，使他们能够通过网络与我们的精神科多学科团队建立支持性的专业关系。会议平台。这项新生服务可能会成为初级临床医生和专科精神病学服务更有效地利用时间的途径。目的：描述农村临床医生/用户的人口统计数据，描述该模型如何满足未满足的临床医生专业需求，并确定它是否可以提高临床医生的信心。它还将提供一个论坛，澳大利亚GP社区成员可以在其中发表评论和建议。方法：2015年，在新南威尔士州三个资源贫乏的地方卫生区和一个非政府组织的农村和偏远地区的临床医生提供了这项服务。在最初的12个月中，人口统计学数据，吸收率，用户满意度以及干预前后的临床医生信心收集了措施。结果：100名注册者参加了15个教育论坛，25个案例会议和14个监督会议。置信度调查表显示置信度取决于临床医生，执业环境和执业年限（工作1-5年的人最自信，其次是工作21年以上的人）。临床医生确定的最突出的需求领域是教育患者的护理人员，以及有关临床老年精神病的教育和病例会议。所有用户都多次使用该服务。结论：有必要建立农村电子卫生保健的老年医学SOS模型，这可能是迈向更进一步的一步

Psychogeriatric SOS: A unique clinician-to-clinician web-based service for rural and remote clinicians

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